Objective To investigate the therapeutic effect of esomeprazole,a new type 0f proton pump inhibitor(PPI),on patients with reflux esophagitis(RE).Methods 80 cases with RE diagnosed by endoscope were randomly divided into treatmeat group(n=40)and control group(n=40).The treatmeat group was treated with esomeprazole 20 mg bid,compared with the control group famotidine 20mg bid.The two courses of treatment both persisted for four weeks and included mosapride 5mg tid.At the end of therapy,the rate of relief of heartburn,acid reflux and substernal burning symptom,and the total effective rate confirmed by endoscope were recorded.ResuIts The clinical symptoms relief rates were 92.5%in the treatment and 62.5%in the control group raspectively and had obviously statistical difference(P＜0.05).The total effective rate was confirmed by endoscope were 82.5%and 55.0%respectively in two groups(P＜0.05).Conclusion Esomeprazole is a type of effective drug for patients with RE.

Objective: To analyze the predictive value of postoperative lymph node status for adjuvant therapy in esophageal cancer patients after radical resection. Methods: The indexes related to postoperative lymph node of 354 patients with esophageal carcinoma, who underwent radical surgery during a period between January 2007 and December 2010, were retrospectively analyzed. Univariate analysis was performed by Log-rank test and multivariate analysis by a Cox regression model. Results: The 1-, 3- and 5-year overall survival (OS) rates were 84.46%, 64.12% and 54.06%, respectively, and the median survival time was 86.49 months. The 5-year OS rate of N0, N1, N2 and N3 stage patients were 93.13%, 55.50%, 19.80% and 3.45%, respectively. And it is obviously different from each other in PN stage (χ2=225.161, P<0.001). We used the cut-off value of LNR 8.51% which was obtained by ROC curve to divide the patients into two groups. The 5-year survival rates of the group with LNR≤8.51% and the group with LNR>8.51% were 81.63% and 23.40%, respectively. There were significant differences between the two groups (χ2=143.504, P<0.001). The results of univariate analysis showed that PT stage, PN stage, LNR and number of negative lymph nodes were significantly correlated with OS (all P<0.05). Multivariate analysis showed that the PN stage and LNR were independent factors for OS (all P<0.05). The patients in the PN2 and LNR >8.51% groups with adjuvant therapy showed a significantly better survival than those with surgery alone and without adjuvant therapy (χ2=12.609, P< 0.001; χ2=13.171, P<0.001). The patients in the group with PN2 stage as well as LNR >8.51% who had undergone adjuvant therapy showed a significantly better survival than those with simple surgery and without adjuvant therapy (χ2=12.609, P<0.001). Conclusions: The combination of PN stage and LNR as a better factor for predicting the prognosis of patients with esophageal cancer after radical resection can predict the value of adjuvant therapy. The patients with PN2 stage and higher LNR should choose postoperative adjuvant therapy.

Objective To investigate the effect of suppressor of cytokine signaling-1 (SOCS-1)on expression of monocyte chemoattractant protein-1 (MCP-1)in human glomerular mesangial cells (HMCs) under high concentration of glucose. Methods Stable transfections of HMC with pCR3.1 vector and pCR3. 1-SOCS-1 were performed with hpofectamine 2000, and cells were selected with geneticin. Cells were stimulated with low glucose (LG, 5.5 mmol/L), high glucose (HG, 30 mmol/L), LG plus mannitol (24.5 mmol/L) and AG490 (10 μmol/L). The protein expression levels of SOCS-1, signal transducer and activators of transcription 1,3 (STAT1, STAT3),p-STAT1 and p-STAT3 were observed by Western blotting. The protein synthesis of MCP-1, FN and type Ⅳ collagen in the supernatants of the HMCs were detected by ELISA and radioimmunoassay. The expression level of SOCS-1 and MCP-1 mRNA was measured by BT-PCR.Results HG induced the expression of SOCS-1 protein and mRNA in HMCs in time-dependant manner, peaked at 4 h, and gradually decreased to baseline at 24 h. Compared with low glucose control group, the phosphorylation levels of STAT1 and STAT3 and the expression of MCP-1 mRNA [(0.39±0.05) vs (0.16±0.02)]were significantly increased in HMCs under high glucose medium (P ＜0.01 ). Exposure of HMCs to high glucose conditions showed high concentration of MCP-1 [(459±67) ng/L vs (241±19) ng/L], fibronectin [(5.84±0.61) mg/L vs (3.41±0.31) mg/L]and type Ⅳ collagen [(16.45±2.30) μg/L vs (9.56±1.52) μg/L]in the supernatants (all P＜0.01).Overexpression of SOCS-1 inhibited the phosphorylation levels of STAT1 and STAT3 and the expression of MCP-1 mRNA [(0.34±0.04) vs (0.42±0.05)]in HMCs under high glucose condition (all P＜0.05). Compared with vector control group, the concentration of MCP-1 [(387±47) ng/L vs (463±56) ng/L], fibronectin [(4.61±0.57) mg/L vs (5.76±0.74) mg/L]and type Ⅳ collagen [(13.4±2.32) μg/L vs (17.1±2.57) μg/L]was decreased in supernatants of HMCs with SOCS-1 overexpression (all P＜0.05). Compared with HG group, the expression of MCP-1 mRNA (0.31±0.04) and the concentration of MCP-1 [(361±53) ng/L], FN [(5.46±0.71) mg/L]and type Ⅳ collagen [(15.2±1.97) μg/L]in supernatants were decreased in HMCs treated with AG490.Conclusion Overexpression of SOCS-1 inhibits overproduction of MCP-1 and ECM proteins in HMCs under high glucose conditions, which may be partly by regulating the phosphoryhtion of STAT1 and STAT3.

Objective To investigate the effects of icarrin on the activity and protein expression of core binding factor otl(Cbfa1) in rat osteoblasts cultured in vitro,and to explore whether mitogen-activated protein kinase (MAPK) pathway is involved in this process.Methods Calvarial osteoblasts were obtained from newborn (<24 h) SD rats by trypsin-coUagenase digestion method.The second generation osteoblasts were cultured in the medium containing icariin (10 ng/ml) or estradiol (10-8 mol/L) with or without extracellular-signal regulated kinase (ERK) inhibitor (UO126) or p38MAPK inhibitor (SB203580).Nuclear protein was extracted from osteoblasts.And then the activity of Cbfa1 was detected by ELISA.The amounts of Cbfa1 protein were detected by Western blot.Results Calvarial osteoblasts were obtained successfully and were used in this study after indentified by alkaline phosphatase and mineralized nodus staining.Cbfa1 expression and the activity in osteoblasts were up-regulated by both icariin and estradiol (P<0.05).The effects were partly inhibited by addition of U0126or SB203580 (P<0.05).Conclusions Either icarrin or estradiol can stimulate the proliferation and maturation of cultured osteoblasts in vitro via up-regulating the activity and expression of Cbfal.The MAPK signal pathway inhibitor seems to partly decrease Cbfa1 activity.It suggests that MAPK pathway may be involved in the transduction of icariin's impact on proliferation and mineralization of osteoblasts.

Objective To compare dose-volume parameters for local failure in esophageal cancers treated by there-dimensional conformal radiotherapy (3 D-CRT) or intensity modulated radiotherapy (IMRT) with different target regions.Methods A total of 244 patients with esophageal cancer (including 127 patients with local recurrence and 117 without recurrence) underwent radical 3D-CRT and IMRT were enrolled in this study.Data including dose-volume parameters and clinical features were analyzed retrospectively.Results No statistically significant differences were found in the dose-volume parameters of different planning target regions between groups with local tumor recurrence and without recurrence (P ＞ 0.05).In the elective nodal irradiation(ENI) group, neither the recurrence and the non-recurrence groups showed statistical differences in the dose-volume parameters (P ＞ 0.05).While for the involved-field iradiation(IFI) group, the GTV-V60, CTV-V60, PTV-V60 of local recurrent group were significantly lower than those in the non-recurrent group (t =-2.08,-2.19,-2.08, P ＜ 0.05).In the ENI group, radiated doses of GTV, CTV and PTV as well as dose-volume of PTV were significantly higher than the IFI group (t =1.97-3.12, P ＜ 0.05).For patients with a esophageal GTV less than 30 cm3 but without concurrent chemotherapy, radiated dose of CTV-D98％ , CTV-D95％ in the recurrent group were significantly lower than in non-recurrent group (t =-2.24--2.07, P ＜ 0.05).Conclusions Elective nodal prophylactic radiation of esophageal carcinoma could provide greater volume and doses of GTV, CTV and PTV to prescribed target regions, which may decrease local recurrence.Greater efficiency can be obtained when the primary lesion of the esophageal cancer is smaller or at an early stage, and concurrent chemotherapy is not given.

Objective Study the diagnostic value of CT to assess the transfer of right recurrent nerve nodes(RRNN) on the thoracic esophageal squamous carcinoma,so as to provide reference for thoracic segment esophageal surgery way.Methods A retrospective analysis from January 2011 to February 2014 in the first affiliated hospital of zhengzhou university at the records of 132 cases of thoracic segment esophageal thoracic surgery with preoperative CT image data,recorded each patient's right recurrent nerve nodes in the largest length to diameter and the average CT number,and compared with postoperative pathologic results.Results With the ROC curve analysis,considering transfer when the length of RRNN' s diameter 8.5 mm or more in CT,the area under the curve is 0.911,the sensitivity is 85.7％,specificity is 78.8％.Considering transfer when the RRNN average CT number acuity 32.50 HU,the area under the curve is 0.815,the sensitivity is 85.7％,specificity is 76.9％.Whether RRNN transfer has significant correlation(P ＜ 0.05) with the length of tumor,tumor location and whether lymph node of other station transfer,doesn' t have significant correlation (P ＞ 0.05)with patients'age,sex,tumor differentiation degree and the T stage.Conclusion When the RRNN length to diameter 8.5 mm or RRNN average CT numberr acuity 32.50 HU,right recurrent nerve nodes should be considered lymph node metastasis,and choose chest conclusion laparoscopic radical prostatectomy.The upper thoracic portion esophageal tumor's length is 5 cm or more,or clinical suspected lymph node metastasis of other station is the risk factor for metastasis of RRNN.

Objective The aim of this study was to evaluate the prognosis of resection followed by chemotherapy compared with chemoradiotherapy for limited-stage small cell lung cancer .Methods The clinical data of 230 limited-stage small cell lung cancer patients with curative treatment between January 2006 and December 2011 were retrospectively analyzed .All patients divided to two group: the resection plus chemotherapy ( S +C ) and chemoradiotherapy ( R +C ) .And the prognostic factors were further analyzed with limited stage small cell lung cancer .The Kaplan-Meier method was used for the survival analysis.Results The overall survival rates of 1-year, 3-year and 5-year were 87.0%, 38.9%, 25.4%, respectively and the media survival time ( MST) 26.0 months.When patients were stratified by clinical stageⅠ+Ⅱ, the 1-year , 3-year and 5-year overall survival rates of S +C group and R +C group were 92.6%, 63.2%, 47.3%and 76.2%, 42.9%, 30.6%, respectively (χ2 =7.851, P<0.05), while those were 88.5%, 26.9%, 10.6% and 86.0%, 25.1%, 25.1%, respectively in stage ⅢA with no significant difference ( P >0.05).In univariate analysis, tumor location, tumor stage, lymph node metastasis, TNM stage, the cycle of chemotherapy , treatment modalities were significantly associated with survival ( RR=1.735, P<0.05).The multivariate analysis only showed TNM stage were independent factors of prognosis .Conclusions The results suggested that resection plus chemotherapy could improve the prognosis of early-stage(stageⅠ+Ⅱ) small cell lung cancer, but patients in ⅢA stage should received the definitive chemoradiotherapy .The TNM stage was still the independent factor of prognosis .

Aim To investigate the effects of fluvastatin on epithelial-myofibroblast transdifferentiation and activation of ERK1/2 in HKC cells stimulated by AGEs. Methods HKC are divided into four groups: control group, AGEs group, AGEs plus fluvastatin group and AGEs plus ERK1/2 MAP kinase inhibitor PD98059 group. Immunocytochemistry staining was used to detect expression of ?-SMA. The protein expressions of ?-SMA, E-cadherin, Col I, ERK1/2 and p-ERK1/2 were observed by Western blot. The protein synthesis of TGF-?1 in the supernatants of the HKC was detected by enzyme-linked immunoadsorbent assay (ELISA).?-SMA and E-cadherin mRNA were measured by reverse transcription and polymerase chain reaction (RT-PCR). Results Compared with those of control group,the expressions of ?-SMA protein and mRNA,and Col I were significantly increased in HKC cells with AGEs stimulation and there was high concentration of TGF-?1 in the supernatants. However, the expressions of E-cadherin protein and mRNA were decreased with AGEs stimulation. AGEs induced ERK1/2 phosphorylation in HKC in a time-dependent manner, being significant at 15 minutes and peak occured at 1 h. PD98059 and fluvastatin inhibited AGEs-induced activation of ERK1/2 and high expression of Col I and ?-SMA protein and mRNA, and reversed the expression of E-cadherin protein and mRNA induced by AGEs. Meanwhile, fluvastatin and PD98059 reduced the concentration of TGF-?1 in the supernatants of HKC with AGEs stimulation. Conclusions Fluvastatin inhibited AGEs-induced HKC epithelial-myofibroblast transdifferentiation and collagen I synthesis might be partly through blocking activation of ERK1/2.

Objective To investigate the application value of root seeking method and suspension method in lymph nodes dissection of recurrent laryngeal nerve (RLN) during minimally invasive McKeown surgery of thoracic esophageal cancer.Methods The retrospective cohort study was conducted.The clinical data of 120 patients with thoracic esophageal cancer who were admitted to the First Affiliated Hospital of Zhengzhou University from March 2015 to May 2016 were collected.Sixty patients using root seeking method and suspension method in lymph nodes dissection of RLN were allocated into the study group,and 60 using unexposed lymph nodes dissection of RLN were allocated into the control group.All the patients underwent minimally invasive McKeown surgeries.Observation indicators:(1) intraoperative situations;(2) postoperative situations;(3) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative tumor recurrence or metastasis and injury of RLN up to January 2017.Measurement data with normal distribution were represented as-x±s.Comparisons between groups were evaluated with the independent-sample t test.Count data were analyzed using the chi-square test.Results (1) Intraoperative situations:patients between groups underwent successful minimally invasive McKeown surgery,without conversion to open surgery.The operation time and volume of intraoperative blood loss were respectively (250± 19)minutes,(484±80)mL in the study group and (248±22) minutes,(493±60)mL in the control group,with no statistically significant difference between groups (t =0.532,-0.697,P＞0.05).The number of lymph nodes dissection,successful dissection rate and metastasis rate in the left RLN and metastasis rate in the right RLN were respectively 5.0±4.1,86.7％ (52/60),23.3％ (14/60),16.7％ (10/60) in the study group and 1.0±0.9,60.0％ (36/60),1.7％ (1/60),5.0％ (3/60) in the control group,with statistically significant differences between groups (t =5.170,x2=10.909,12.876,4.227,P＜0.05).The number of lymph nodes dissection,successful dissection rate and metastasis degree in the right RLN and metastasis degree in the left RLN were respectively 3.5±3.6,93.3％(56/60),8.55％(20/234),7.69％ (20/260) in the study group and 1.5± 1.0,83.3％ (50/60),4.00％ (4/100),1.72％ (1/58) in the control group,with no statistically significant difference between groups (t=1.075,x2 =2.911,2.172,1.856,P＞0.05).(2) Postoperative situations:time to initial anal exsufflation,time of initial defecation and time for initial fluid diet intake were respectively (2.0±0.6)days,(3.1 ± 0.6)days,(7.2± 0.3)days in the study group and (2.2±0.8) days,(3.2±0.5) days,(6.9±0.5) days in the control group,with no statistically significant difference between groups (t=2.618,-0.991,3.985,P＞0.05).Comparisons of injury degree of RLN:5 and 1 patients in the study and control groups had mild injury,respectively,showing no statistically significant difference between groups (x2=1.581,P＞0.05);1 and 8 patients in the study and control groups had respectively moderate injury,showing a statistically significant difference between groups (x2 =4.323,P＜0.05);there was no severe injury between groups.Duration of hospital stay in the study and control groups were respectively (14.8±2.5)days and (14.5±2.8) days,showing no statistically significant difference between groups (t =0.619,P＞ 0.05).(3)Follow-up:120 patients were followed up for 4-22 months,with a median time of 13 months.During the follow-up,3 and 2 patients in the study and control groups had cervical lymph node metastases and received postoperative assisted chemotherapy and local radiotherapy of neck,without death between groups.There was no hoarseness in 6 patients with mild injury of RLN during the follow-up;voices in 9 patients with moderate injury of RLN were improved at 1-2 months postoperatively,and no bucking symptom was detected after fluid diet intake.Conclusion The root seeking method and suspension method in lymph nodes dissection of RLN is safe and effective during minimally invasive McKeown surgery of thoracic esophageal cancer,especially conducive to lymph nodes exposure and dissection of the left RLN,and reduce the incidence of moderate injury of RLN.